Management of Chronic Spontaneous Urticaria with Cyclosporine in the Era of Omalizumab

  • Bárbara Roque Ferreira Médica Interna de Dermatovenereologia, Serviço de Dermatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Maria Inês Ribeiro Aluna do Mestrado Integrado em Medicina, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
  • Margarida Gonçalo Chefe de Serviço de Dermatovenereologia, Serviço de Dermatologia, Centro Hospitalar e Universitário de Coimbra, e Professora da Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
Keywords: Cyclosporine, Omalizumab, Urticaria/drug therapy.

Abstract

Introduction: In chronic spontaneous urticaria (CSU) unresponsive to anti H1-histamines, national recommendations propose omalizumab, which is not always promptly available. Thus, other treatments should be discussed. In this context, we have analysed efficacy and safety of cyclosporine and possible relations between characteristics of urticaria and response to cyclosporine.

Material and Methods: Retrospective study of CSU patients from a department of dermatology treated with cyclosporine (2010-2016). We evaluated the demographic and clinic-laboratorial parameters, doses, treatment duration, follow-up, side effects and efficacy, using the weekly urticarial activity score 7 (UAS7). Statistical significance was considered for p < 0.05.

Results: We evaluated 23 patients (19 female/4 male; mean age 46.0y ± 14.0) with CSU which evolved for 129.7 ± 128.1 months and who were treated with cyclosporine (mean dose 3.2 ± 0.3 mg/kg). There was a good response in 10 patients (44%) at the first month, with a significant mean UAS7 reduction. Side effects from cyclosporine occurred in eight patients, leading to treatment suspension in six patients (26%), mostly due to arterial hypertension and infections. None of the parameters evaluated was associated with response to cyclosporine.

Conclusion: Cyclosporine was effective in 44% of patients with moderate to severe CSU. When omalizumab is not immediately available, it may be worth trying cyclosporine, with a narrow monitoring for adverse effects.

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Published
2018-05-29
How to Cite
Ferreira, B. R., Ribeiro, M. I., & Gonçalo, M. (2018). Management of Chronic Spontaneous Urticaria with Cyclosporine in the Era of Omalizumab. Journal of the Portuguese Society of Dermatology and Venereology, 76(2), 157-164. https://doi.org/10.29021/spdv.76.2.880
Section
Original Articles